Fibrates are a type of medication that’s usually prescribed to treat high cholesterol. Fibrates are recommended only after doctors have performed a lipid panel and have full information on what a person’s current cholesterol level is. Normally, medication to treat high cholesterol is only given in more extreme situations, when cholesterol levels are through the roof, or when lifestyle changes have not yielded the expected results.
How fibrates work
Fibrates are also known as fibric acid derivatives, a class of drugs prescribed to people with high cholesterol levels. What fibrates actually do is to lower triglyceride count, making sure that the liver produces less VLDL. To explain the two concepts:
- Triglycerides are a lipid (fat) found in the human body. They come along when your body has excess calories, which can be stored for later use. Triglycerides are basically calories converted into potential energy sources, so that the body may release them between meals, when energy levels drop. Triglycerides reside in fat cells. When you eat foods that are rich in sugar or carbohydrates, the body turns these calories into triglycerides.
- VLDL stands for "very-low-density lipoprotein". It is produced in the liver and then released into the bloodstream. VLDL is very similar to LDL as they are both labeled as “bad cholesterol” lipids, but their composition is a bit different. VLDL is mostly made of triglycerides, while the main component of LDL is cholesterol. Both VLDL and LDL are dangerous when they exceed certain thresholds, because they can cause plaque build-up on the artery walls, leading to a number of health complications, the most severe ones being stroke and heart disease.
Benefits of fibrates
A few studies have revealed the fact that fibrates can also slightly increase the level of HDL (or good cholesterol) in the blood, but it is much more efficient in working against triglycerides. Research also shows that fibrates are inefficient in lowering bad cholesterol levels (LDL).
If a patient has a high triglyceride count (which is everything above 1.000 mg/dL), doctors will often prescribe a combination of fibrates and statins, in order to compensate for the fact that fibrates do no lower LDL levels. It’s typically difficult to give a person one single drugs that work to lower both LDL and triglycerides, while also increasing the HDL cholesterol level, so combinations of several classes of medication works best in such a scenario.
Some of the most common fibrates prescribed to lower triglycerides count are fenofibrate and gemfibrozil. The latter is also prescribed as a standalone drug to people that are at great risk of heart attack caused by an elevated level of triglycerides, but research has shown that it doesn’t impact the survival rate of people with high cholesterol.
Briefly put, fibrates can:
- Lower your triglyceride count by 20 to 50 percent (depending on how your body responds to the treatment).
- Increase good cholesterol levels between 10 and 35 percent.
- Reduce the risk of having atherosclerosis.
- Reduce the number of heart attacks (non-fatal ones are not included, as research concludes that fibrate treatment does not reduce mortality rate due to high cholesterol causes).
Possible side effects of fibrates
Almost every type of medication has potential side effects. Whether you end up with any really depends on how you respond to treatment with a given drug.
People with a high triglyceride count that take fibrates can potentially have side effects that appear before the body has time to adjust to the drug. Some of these side effects include an upset stomach or nausea.
With fibrates, most of the side effects are at a gastrointestinal level, and will usually disappear after a while, as you get adjusted to the presence of the drug in your body. However, there are very rare cases when fibrates cause liver irritation which, in a more advanced state, may require stopping the drug. In most cases when this liver inflammation occurs, the effects are mild and reversible, so there is no need for long-term concern.
Extensive treatment with fibrates is also known to cause gallstones. These are stones formed in the bile ducts or gallbladder, but which can be removed.
Fibrates and statins
As mentioned above, fibrates may be most efficient when paired with a suitable statin-drug, so that the combination may work to both lower triglyceride count, as well as high cholesterol levels. Even so, there are certain combinations of fibrates and statins that can cause major side effects.
For example, fenofibrate is a fibrate that does not interfere with the action of statins, but gemfibrozil does, and doctors generally avoid combining it with such a drug. Gemfibrozil interacts with certain statins and can potentially lead to muscle toxicity, as they increase the level of statin in the blood. You doctor will know all these combinations and will prescribe a fibrate only with a suitable statin, making sure it doesn’t have a negative impact on your health.
People who have a high triglyceride count, but don’t have abnormal LDL levels in their body would very much benefit from a treatment with fibrate drugs. Studies have shown that fibrates are a great treatment for people that need to lower their triglyceride concentration, as they can reduce VLDL with about 40 percent, while also increasing HDL cholesterol levels with about 10 percent.
Since they are not efficient in lowering LDL count, fibrates are usually prescribed alongside some other treatment for bad cholesterol, such as statins, if the patient also needs medication for lowering high cholesterol.